Cough and exhaled nitric oxide levels: what happens with exercise?

Helen L Petsky, Jennifer Anne Kynaston, Margaret McElrea, Catherine Turner, Alan Isles, Anne B Chang, Helen L Petsky, Jennifer Anne Kynaston, Margaret McElrea, Catherine Turner, Alan Isles, Anne B Chang

Abstract

Cough associated with exertion is often used as a surrogate marker of asthma. However, to date there are no studies that have objectively measured cough in association with exercise in children. Our primary aim was to examine whether children with a pre-existing cough have an increase in cough frequency during and post-exercise. We hypothesized that children with any coughing illness will have an increase in cough frequency post-exercise regardless of the presence of exercise-induced broncho-constriction (EIB) or atopy. In addition, we hypothesized that Fractional exhaled nitric oxide (FeNO) levels decreases post-exercise regardless of the presence of EIB or atopy. Children with chronic cough and a control group without cough undertook an exercise challenge, FeNO measurements and a skin prick test, and wore a 24-h voice recorder to objectively measure cough frequency. The association between recorded cough frequency, exercise, atopy, and presence of EIB was tested. We also determined if the change in FeNO post exercise related to atopy or EIB. Of the 50 children recruited (35 with cough, 15 control), 7 had EIB. Children with cough had a significant increase in cough counts (median 7.0, inter-quartile ranges, 0.5, 24.5) compared to controls (2.0, IQR 0, 5.0, p = 0.028) post-exercise. Presence of atopy or EIB did not influence cough frequency. FeNO level was significantly lower post-exercise in both groups but the change was not influenced by atopy or EIB. Cough post-exertion is likely a generic response in children with a current cough. FeNO level decreases post-exercise irrespective of the presence of atopy or EIB. A larger study is necessary confirm or refute our findings.

Keywords: FeNO; atopy; cough; exercise-induced broncho-constriction; pediatrics.

Figures

Figure 1
Figure 1
Flowchart of methods.
Figure 2
Figure 2
Box plot (median and IQR) depicting the number of coughs 30 min post exercise in the coughers and controls. The median number of coughs was significantly higher in the coughers compared to controls.

References

    1. Marchant JM, Newcombe PA, Juniper EF, Sheffield JK, Stathis SL, Chang AB. What is the burden of chronic cough for families? Chest (2008) 134:303–910.1378/chest.07-2236
    1. Dryden DM, Spooner CH, Stickland MK, et al. Exercise-Induced Bronchoconstriction and Asthma. Evidence Report/Technology Assessment No. 189 (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290-2007-10021-I) AHRQ Publication No. 10-E001. Rockville, MD: Agency for Healthcare Research and Quality; (2010).
    1. Suguikawa TR, Garcia CA, Martinez EZ, Vianna EO. Cough and dyspnea during bronchoconstriction: comparison of different stimuli. Cough (2009) 5:6.10.1186/1745-9974-5-6
    1. Lavorini F, Fontana GA, Chellini E, Magni C, Duranti R, Widdicombe J. Desensitization of the cough reflex by exercise and voluntary isocapnic hyperpnea. J Appl Phys (2010) 108:1061–810.1152/japplphysiol.00423.2009
    1. Chang AB. Therapy for cough: where does it fall short? Expert Rev Respir Med (2011) 5:503–1310.1586/ers.11.35
    1. Widdicombe J, Fontana G, Gibson P. Workshop – cough: exercise, speech and music. Pulm Pharmacol Ther (2009) 22:143–710.1016/j.pupt.2008.12.009
    1. Szefler S. Facing the challenges of childhood asthma: what changes are necessary? J Allergy Clin Immunol (2005) 115:685–810.1016/j.jaci.2005.01.031
    1. Terada A, Fujisawa T, Togashi K, Miyazaki T, Katsumata H, Atsuta J, et al. Exhaled nitric oxide decreases during exercise-induced bronchoconstriction in children with asthma. Am J Respir Crit Care Med (2001) 164:1879–8410.1164/ajrccm.164.10.2009105
    1. Scollo M, Zanconato S, Ongaro R, Zaramella C, Zacchello F, Baraldi E, et al. Exhaled nitric oxide and exercise-induced bronchoconstriction in asthmatic children. Am J Respir Crit Care Med (1999) 160:1047–50
    1. Silkoff PE, Erzurum SC, Lundberg JO, George SC, Marczin N, Hunt JF, et al. ATS workshop proceedings: exhaled nitric oxide and nitric oxide oxidative metabolism in exhaled breath condensate. Proc Am Thorac Soc (2006) 3:131–4510.1513/pats.200406-710ST
    1. Eigen H, Bieler H, Grant D, Christoph K, Terrill D, Heilman DK, et al. Spirometric pulmonary function in healthy preschool children. Am J Respir Crit Care Med (2001) 163:619–2310.1164/ajrccm.163.3.2002054
    1. Hibbert ME, Lannigan A, Landau LI, Phelan PD. Lung function values from a longitudinal study of healthy children and adolescents. Pediatr Pulmonol (1989) 7:101–910.1002/ppul.1950070209
    1. Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med (2000) 161:309–2910.1164/ajrccm.161.1.ats11-99
    1. Haby MM, Anderson SD, Peat JK, Mellis CM, Toelle BG, Woolcock AJ. An exercise challenge protocol for epidemiological studies of asthma in children: comparison with histamine challenge. Eur Respir J (1994) 7:43–910.1183/09031936.94.07010043
    1. Carlsen KH, Engh G, Mark M. Exercise-induced bronchoconstriction depends on exercise load. Respir Med (2000) 94:750–510.1053/rmed.2000.0809
    1. Godfrey S, Springer C, Bar-Yishay E, Avital A. Cut-off points defining normal and asthmatic bronchial reactivity to exercise and inhalation challenges in children and young adults. Eur Respir J (1999) 14:659–6810.1034/j.1399-3003.1999.14c28.x
    1. Sheppard D, Rizk NW, Boushey HA, Bethel RA. Mechanism of cough and bronchoconstriction induced by distilled water aerosol. Am Rev Respir Dis (1983) 127:691–4
    1. Koskela HO, Kontra KM, Purokivi MK, Randell JT. Interpretation of cough provoked by airway challenges. Chest (2005) 128:3329–3510.1378/chest.128.5.3329
    1. Koskela HO, Martens R, Brannan JD, Anderson SD, Leuppi J, Chan HK. Dissociation in the effect of nedocromil on mannitol-induced cough or bronchoconstriction in asthmatic subjects. Respirology (2005) 10:442–810.1111/j.1440-1843.2005.00724.x
    1. Kippelen P, Caillaud C, Robert E, Masmoudi K, Préfaut C. Exhaled nitric oxide level during and after heavy exercise in athletes with exercise-induced hypoxaemia. Pflugers Arch (2002) 444:397–40410.1007/s00424-002-0816-y
    1. Rietveld S, Rijssenbeek-Nouwens LH, Prins PJ. Cough as the ambiguous indicator of airway obstruction in asthma. J Asthma (1999) 36:177–8610.3109/02770909909056315
    1. Gibson PG, Chang AB, Glasgow NJ, Holmes PW, Katelaris P, Kemp AS, et al. CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian cough guidelines summary statement. Med J Aust (2010) 192:265–71
    1. British Guideline on the Management of Asthma A National Clinical Guideline (2008). [cited 2008]. Available from:
    1. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (Full Report 2007) (2012) [cited November 2012]. Available from:
    1. Matsumoto A, Hirata Y, Momomura S, Fujita H, Yao A, Sata M, et al. Increased nitric oxide production during exercise. Lancet (1994) 343(8901):849–5010.1016/S0140-6736(94)92047-8
    1. Phillips CR, Giraud GD, Holden WE. Exhaled nitric oxide during exercise: site of release and modulation by ventilation and blood flow. J Appl Phys (1996) 80(6):1865–71
    1. Persson MG, Wiklund NP, Gustafsson LE. Endogenous nitric oxide in single exhalations and the change during exercise. Am Rev Respir Dis (1993) 148(5):1210–410.1164/ajrccm/148.5.1210
    1. Chang AB, Gibson PG, Willis C, Petsky HL, Widdicombe JG, Masters IB, et al. Do sex and atopy influence cough outcome measurements in children? Chest (2011) 140(2):324–3010.1378/chest.10-2507
    1. Marchant JM, Masters IB, Taylor SM, Chang AB. Utility of signs and symptoms of chronic cough in predicting specific cause in children. Thorax (2006) 61(8):694–810.1136/thx.2005.056986

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